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OBJECTIVE: Childbirth is considered to be both beautiful and traumatic. Following a vaginal delivery, some women express discontent with the appearance of their genitalia on social media and/or websites. This study explored how some women perceived their genitalia, post childbirth. Three groups were compared: women with a vaginal delivery, those with a cesarean-section, and those who had never given birth. METHODS: After the study received approval from the institutional review board, 224 female participants living in Puerto Rico and aged 21 to 42 years completed a questionnaire about their genital self-image. RESULTS: Approximately 51% (n = 115) of the participants had never given birth; the others had given birth via C-section 23% (n = 51) or vaginally 26% (n = 58). In all 3 groups, 84% felt positive about their genitals, 79% expressed their satisfaction with the appearance of their genitals and 84%, with their size; 81% were not ashamed of their genitals. CONCLUSION: Logistic regression found no significant difference in genital self-perception between delivery groups or nulliparous women. The adjusted odds ratios for positive genital image varied slightly between delivery methods but were not statistically significant (ranging from 0.65 to 1.11 for vaginal deliveries, and 0.42 to 1.00 for C-sections; P > .05). This suggests that the method of delivery does not have a significant impact on women's genital self-perception. However, for the 21% with negative perceptions, targeted support is essential; for those struggling with their self-image after childbirth, our results can inform support services to address concerns.

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OBJECTIVE: This study describes the frequency of obstetric anal sphincter injuries (OASIS) in patients after instrumental delivery according to the type of forceps used. METHODS: A retrospective comparative cohort study was conducted on patients who underwent instrumental delivery from January 2017 to April 2022. The primary outcome was the presence of OASIS following delivery. Patients were categorized into Cohort A if only rotation forceps were used, Cohort B for only traction forceps, and Cohort C if both types were used sequentially. Statistical analysis was performed with SPSS (IBM, New York, NY) with χ2, Fisher's exact, and analysis of variance testing. A P-value <0.05 was considered significant. RESULTS: OASIS occurred in 45 of 328 instrumental deliveries. OASIS after rotation forceps occurred in 12.9% (n = 8) of cases, after traction forceps in 13.2% (n = 34), and after sequential use of rotation and traction forceps in 37.5% (n = 3) of cases (p = 0.141). An odds ratio (OR) of 0.91 (95% confidence interval [CI] 0.40-2.08) for OASIS was obtained with the use of rotation forceps, 0.81 (95% CI 0.38-1.70) for traction forceps, and 3.97 (95% CI 0.91-17.2) for the sequential use of rotation and traction forceps. CONCLUSION: There were no significant differences in the presence of OASIS comparing traction and rotation forceps. A non-significant trend of higher OASIS following the sequential use of traction and rotation forceps was observed.

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Objective: We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section. Methods: A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration. Results: One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration. Conclusion: Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration.

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BACKGROUND: Female sexual dysfunction (FSD), including vaginal laxity (VL), can lead to a decrease in quality of life and affect partner relationships. AIM: We aimed to investigate the associated factors of VL and FSD and their relationship with other pelvic floor disorders in a female population. METHODS: This cross-sectional study was conducted at Chelsea and Westminster Hospital from July to December 2022. All women referred to clinical care at the urogynecology clinic were included. Participants were assessed according to sociodemographic and clinical aspects, the Pelvic Organ Prolapse Quantification system, sexual function, VL, sexual attitudes, sexual distress, sexual quality of life, vaginal symptoms, and pelvic floor disorders. Unadjusted and adjusted associated factors of VL and FSD were analyzed. OUTCOMES: The primary outcome was the identification of the associated factors of VL and FSD in a female population, and secondary outcomes included the association between VL and pelvic organ prolapse (POP) with the questionnaire scores. RESULTS: Among participants (N = 300), vaginal delivery, multiparity, perineal laceration, menopause, and gel hormone were significantly more frequent in those reporting VL (all P < .05). When compared with nulliparity, primiparity and multiparity increased the odds of VL by approximately 4 and 12 times, respectively (unadjusted odds ratio [OR], 4.26 [95% CI, 2.05-8.85]; OR, 12.77 [95% CI, 6.53-24.96]). Menopause and perineal laceration increased the odds of VL by 4 and 6 times (unadjusted OR, 4.65 [95% CI, 2.73-7.93]; OR, 6.13 [95% CI, 3.58-10.49]). In multivariate analysis, menopause, primiparity, multiparity, and POP remained associated with VL. CLINICAL IMPLICATIONS: Parity, as an obstetric factor, and menopause and staging of POP, as clinical factors, were associated with VL. STRENGTHS AND LIMITATIONS: The investigation of associated factors for VL will contribute to the understanding of its pathophysiology. The study design makes it impossible to carry out causal inference. CONCLUSION: Menopause, primiparity, multiparity, and POP were highly associated with VL complaints in multivariate analysis.

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ABSTRACT BACKGROUND AND OBJECTIVES: Pain is the most frequently reported symptom in the immediate puerperium. The aim of this study was to quantify pain levels and sociodemographic, obstetric, and care characteristics associated with severe pain and inadequate analgesia according to the mode of delivery. METHODS: Observational, descriptive, cross-sectional study conducted between October and December 2020, with a sample of 229 postpartum women considered eligible (baby born alive, weighing > 500 g and/or gestational age > 22 weeks) to answer the study questionnaire. RESULTS: The mean reported pain was 5.34 by Visual Analogue Scale (VAS) and there was a difference (p<0.001) between modes of delivery. Cesarean section was associated with severe pain (p=0.006) and pain above eight on the VAS (p=0.02). Vaginal delivery was associated with the perception of inadequate analgesia (p=0.04). Severe pain reported was associated with the admission of the baby to the ICU (p=0.01) and cases of postpartum hemorrhage (p=0.002). Among women who gave birth vaginally, there was an association between severe pain and instrumental delivery (p=0.05). Reported severe pain was associated with difficulties in self-care (p<0.001) and care of the newborn (p= 0.02), sensation of weakness (p<0.001), and fainting (p=0.002). The perception of inadequate analgesia was associated with vaginal birth (p=0.04) end non-white skin color (p=0,03). CONCLUSION: The average reported pain was moderate. Intense pain and the perception of inadequate analgesia were associated with instrumental delivery, newborns being referred to the NICU, postpartum hemorrhage, and non-white skin color.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor é o sintoma mais frequentemente relatado no puerpério imediato. O objetivo deste estudo foi quantificar os níveis de dor e as características sociodemográficas, obstétricas e da assistência associadas à dor intensa e à percepção de analgesia inadequada segundo a via de nascimento. MÉTODOS: Estudo observacional, descritivo, transversal, conduzido entre outubro e dezembro de 2020, com uma amostra de 229 puérperas consideradas elegíveis (nativivos com peso > 500g e/ou idade gestacional > 22 semanas) para responder ao questionário do estudo. RESULTADOS: A média de dor relatada foi 5,3 pela Escala Analógica Visual (EAV) e houve diferença (p<0,001) entre as vias de nascimento. A cesariana apresentou associação com dor intensa referida (p=0,006) e dor acima de oito pela EAV (p=0,02). O parto vaginal obteve associação com percepção de analgesia inadequada (p=0,04). Entre as mulheres que referiram dor intensa, houve associação com recém-nascido encaminhado à unidade de terapia intensiva neonatal (UTIN) (p=0,01) e nos casos de hemorragia pós-parto (p=0,002). Entre as mulheres que tiveram parto vaginal, também houve associação entre dor intensa e o parto instrumental (p=0,05). Dor intensa referida teve associação com dificuldades para o autocuidado (p<0,001) e do recém-nascido (p=0,02), sensação de fraqueza (p<0,001) e de desmaio (p= 0,002). A percepção de analgesia inadequada esteve associada a parto vaginal (p=0,04) e cor da pele não branca (p=0,03). CONCLUSÃO: A média de dor relatada foi moderada. Dor intensa e percepção de analgesia inadequada estiveram associadas com parto instrumental, recém-nascido encaminhado à UTIN, hemorragia pós-parto e cor de pele não branca.

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La cardiopatía congénita es la afección cardíaca más frecuente que complica los embarazos en los países desarrollados. A su vez, los cambios en el estilo de vida, la mayor edad materna asociada a factores de riesgo cardiovasculares propios de la edad como hipertensión, diabetes y obesidad hace que aumente también la incidencia de enfermedades cardíacas adquiridas. Los cambios fisiológicos normales del embarazo pueden agravar cardiopatías preexistentes. La morbimortalidad materna relacionada con enfermedades cardiovasculares es significativa, por lo que es fundamental realizar un abordaje multidisciplinario e individualizado de estas pacientes. La estratificación del riesgo es esencial para guiar la gestión clínica. La planificación de la finalización de la gestación debe ser individualizada, considerando el riesgo materno y fetal, se debe realizar en un centro de tercer nivel de atención y preferentemente lo más cercano al término para disminuir la morbimortalidad perinatal. El parto vaginal es la vía de elección; en la mayoría de los casos, es fundamental la monitorización continua materna y fetal durante el trabajo de parto y el parto y la vigilancia estricta materna en el puerperio.

Congenital heart disease is the most common heart condition that complicates pregnancies in developed countries. Additionally, changes in lifestyle and older maternal age, along with age-related cardiovascular risk factors such as hypertension, diabetes, and obesity contribute to an increased incidence of acquired heart diseases. The normal physiological changes of pregnancy can exacerbate pre-existing heart conditions. Maternal morbidity and mortality related to cardiovascular diseases are significant, highlighting the need for a multidisciplinary and individualized approach to these patients. Risk stratification is essential for guiding clinical management. Planning the timing of delivery should be individualized, considering both maternal and fetal risks, ideally in a tertiary care center and preferably close to term to reduce perinatal morbidity and mortality. Vaginal delivery is the preferred mode, in most cases, with continuous monitoring of both maternal and fetal well-being during labor and delivery, and strict maternal surveillance in the postpartum period.

A cardiopatia congênita é a condição cardíaca mais comum que complica gestações em países desenvolvidos. Além disso, mudanças no estilo de vida e a idade materna avançada, associadas a fatores de risco cardiovascular relacionados à idade como hipertensão, diabetes e obesidade, contribuem para o aumento da incidência de doenças cardíacas adquiridas. As mudanças fisiológicas normais da gravidez podem agravar condições cardíacas pré-existentes. A morbimortalidade materna relacionada a doenças cardiovasculares é significativa, destacando a necessidade de uma abordagem multidisciplinar e individualizada para essas pacientes. A estratificação de risco é essencial para orientar o manejo clínico. O planejamento da terminação da gestação deve ser individualizado, considerando os riscos maternos e fetais, idealmente em um centro de atendimento terciário e preferencialmente próximo ao termo para reduzir a morbimortalidade perinatal. O parto vaginal é o método preferido na maioria dos casos, com monitoramento contínuo do bem-estar materno e fetal durante o trabalho de parto e o parto, além de uma vigilância rigorosa materna no pós-parto.

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Objective: We aimed to translate and determine cultural validity of the Vaginal Changes Sexual and Body Esteem Scale (VSBE) for Brazilian Portuguese language in postpartum women who underwent vaginal delivery with or without perineal laceration and cesarean section. Methods: A cross-sectional study conducted virtually, with online data collection through a survey with 234 postpartum women of 975 that were invited. Clinical, sociodemographic, and psychometric variables from the VSBE questionnaire were analyzed (content validity index, internal consistency, test-retest reliability, construct/structural and discriminant validity). Multivariate analysis was performed to explore associated factors with the presence of perineal laceration. Results: One-hundred fifty-eight women experienced vaginal delivery, of which 24.79% had an intact perineum, 33.33% had perineal laceration, and 9.4% underwent episiotomy; and 76 participants had cesarean sections. Women with perineal laceration were older, presented dyspareunia and previous surgeries than women without perineal laceration (p<0.05). For VSBE, a high internal consistency (Cronbach's α > 0.7) was observed, but it did not correlate with Body Attractiveness Questionnaire and Female Sexual Function Index; however, it correlated with the presence of women sutured for perineal laceration. Moreover, VSBE presented good structural validity with two loading factors after exploratory factor analysis. VSBE also demonstrated discriminant validity between the presence or absence of perineal laceration. The presence of urinary incontinence (UI) (OR=2.716[1.015-4.667];p=0.046) and a higher VSBE total score (OR=1.056[1.037-1.075];p<0.001) were the only factors associated with perineal laceration. Conclusion: Vaginal Changes Sexual and Body Esteem Scale demonstrated appropriate translation and good internal consistency, discriminant/construct validity and reliability. Vaginal Changes Sexual and Body Esteem Scale total score and presence of UI were associated with women that underwent perineal laceration.

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BACKGROUND: In worldwide literature, it has been found that cesarean deliveries represent higher costs and are associated with maternal morbidity and other complications. OBJECTIVE: This study aimed to estimate the cost-effectiveness of elective cesarean delivery compared with spontaneous vaginal delivery in short-term maternal outcomes for low-risk obstetrical population in Colombia. STUDY DESIGN: A cost-effectiveness study using a healthcare-system perspective was performed in 2019 in Colombia. The reference population were women with full-term and low-risk pregnancy, either by spontaneous vaginal delivery or elective cesarean delivery under medical or nonmedical indications. An analytical decision model (decision tree) was designed for maternal outcomes. The time horizon was 42 days postpartum, and the health effects were measured by Quality Adjusted Life Years. A review of the literature and a validation process by a national expert committee were conducted to determine the maternal outcomes and estimate their probabilities. Costs were estimated with a top-down analysis, an incremental cost-effectiveness ratio was calculated, and finally, a sensitivity analysis was performed. RESULTS: Within a 42-day time horizon, it was found that spontaneous vaginal delivery is the less-expensive and more-effective mode of delivery, it showed a reduction in costs (324 USD) and a gain in Quality Adjusted Life Years (0.03) compared with elective cesarean delivery. Our analysis suggests that spontaneous vaginal delivery is the dominant alternative compared with elective cesarean delivery. CONCLUSION: Spontaneous vaginal delivery showed to be the cost-effective mode of delivery for low-risk obstetrical population in Columbia. These results are useful not only for obstetricians but for decision makers, who should encourage nationwide health policies in favor of spontaneous vaginal delivery.

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Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.

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Objetivos: determinar la proporción de parto vaginal exitoso en mujeres con cesárea previa, describir las complicaciones maternas y perinatales, y realizar una aproximación a los factores asociados al parto vaginal. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres con antecedente de un parto por cesárea, con edad gestacional mayor a 24 semanas y fetos únicos vivos que tuvieron prueba de parto vaginal, atendidas en una institución pública de alta complejidad en 2019. Se excluyeron aquellas pacientes con antecedente de más de una cesárea o miomectomía. Muestreo consecutivo. Se midieron variables sociodemográficas, obstétricas, vía del parto y complicaciones maternas y perinatales. Se hace análisis descriptivo y un análisis exploratorio multivariado de los factores asociados al parto vaginal exitoso. Resultados: de 286 gestantes incluidas, el porcentaje de éxito de parto vaginal fue del 74,5 %. Se identificaron complicaciones maternas en el 3,2 % de los partos vaginales y en el 6,8 % de las cesáreas. El 1,3 % de los recién nacidos tuvo alguna complicación. Hubo 2 muertes perinatales. Se encontró asociación entre parto vaginal exitoso y tener antecedente de parto vaginal (OR: 2,7; IC 95 %: 1,15-6,29); puntaje de Bishop mayor de 6 (OR: 2,2; IC 95 %: 1,03-4,56); inicio de trabajo de parto espontáneo (OR: 4,5; IC 95 %: 2,07-9,6); y edad materna menor de 30 años (OR: 2,28; IC 95 %: 1,2-4,2). Conclusiones: el parto vaginal es una opción segura para considerar en pacientes con cesárea anterior, especialmente si inician trabajo de parto espontáneo o han tenido un parto vaginal previamente. Se requieren cohortes prospectivas para confirmar estos hallazgos.

Objectives: To determine the proportion of successful vaginal deliveries in women with prior cesarean section; to describe maternal and perinatal complications; and to examine the factors associated with vaginal delivery. Materials and methods: Descriptive cross-sectional study of women with a history of cesarean delivery, gestational age of more than 24 weeks, singleton live fetuses, with prior vaginal delivery who received care in a high complexity public institution in 2019. Patients with a history of more than one cesarean section or myomectomy were excluded. Consecutive sampling was used. Sociodemographic and obstetric variables, delivery route and maternal and perinatal complications were measured. A descriptive analysis as well as a multivariate exploratory analysis of the factors associated with successful vaginal delivery were carried out. Results: Among 286 pregnant women included, the percentage of successful vaginal deliveries was 74.5 %. Maternal complications were identified in 3.2 % of vaginal delivery cases and in 6.8 % of cesarean births. Complications occurred in 1.3 % of all live neonates; there were 2 perinatal deaths. An association was found between successful vaginal delivery and a history of prior vaginal delivery (OR: 2.7; 95 % CI: 1.15-6.29); a Bishop score greater than 6 (OR: 2.2; 95 % CI: 1.03-4.56); spontaneous labor initiation (OR: 4.5; IC 95 % CI: 2.07-9.6); and maternal age under 30 years (OR:2.28; 95 % CI: 1.2-4.2). Conclusions: Vaginal delivery is a safe option to consider in patients with prior cesarean section, in particular in cases of spontaneous labor initiation or prior vaginal delivery. Prospective cohorts are needed in order to confirm these findings.

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Introducción: la competencia "asistencia del parto vaginal" se adquiere, parcialmente, mediante simulación en estudiantes de enfermería/obstetricia. Sin embargo, no se ha reportado cuantos partos simulados son necesarios para que estos estudiantes adquieran la mínima competencia. Métodos: estudio cuasi experimental que incluyó a todos los alumnos del internado hospitalario en salud de la mujer, en el segundo semestre del año 2020, excluyendo aquellos que hubieran tenido exposición a la simulación o atención clínica de partos vagina-les. Se evaluó una intervención de práctica simulada en la atención del parto normal en tres etapas: 1) texto, 2) video y 3) simulación. Los estudiantes efectúan tres atenciones simuladas, un evaluador ciego evaluó su rendimiento con una pauta de cotejo (máximo 37 puntos) y se midió la satisfacción con una pauta de evaluación validada. Resultados: el rendimiento de los alumnos mejora significativamente (p < 0.001) con la repetición de la simulación (28,3; 34,3 y 36,7 puntos en 1°, 2° y 3° intento). El porcentaje de estudiantes que logra el umbral de mínima competencia es de 6%, 67% y 100 %, en cada repetición (p < 0.001) Conclusiones: en este grupo de estudiantes, tres repeti-ciones de la simulación/debriefing son suficientes para superar el umbral de mínima competencia. Esta información es útil para definir los recursos necesarios en simulación en atención del parto vaginal en estudiantes de enfermería/obstetricia.

Introduction: Vaginal delivery assistance competence is acquired partially by simulation in nursing/midwifery students. However, it has yet to be reported how many simulated deliveries are necessary for these students to develop the minimum competence. Methods: Quasi-experimental study, all the hospital internship in women>s health students were included in the second semester of 2020, excluding those exposed to the simulation or clinical care of vaginal births. A simulated practice intervention in vaginal delivery care in three stages: 1) text, 2) video, and 3) simulation, was evaluated. The students performed three simulations, a blind observer evaluated their performance with a comparison guideline (maximum 37 points), and their satisfaction was measured with a validated evaluation guideline. Results: The performance of the students improve significantly (p <0.001) with the repetition of the simulation (28.3, 34.3, and 36.7 points in the first, second and third attempts). The percentage of students who achieve the minimum proficiency threshold is 6%, 67%, and 100% in each repetition (p <0.001). Conclusions: In this group of students, three repetitions of the simulation/debriefing are sufficient to exceed the threshold of minimum competence. This information is helpful in defining the necessary resources in simulation in vaginal delivery care in nursing/midwifery students.

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Resumen Introducción: Tanto a nivel sudamericano como mundial, el incremento de la tasa de cesáreas electivas ha sido abrumante. Esto se considera un problema de salud pública, ya que el parto vaginal es la vía más fisiológica para el nacimiento y trae beneficios de salud para la madre y el recién nacido, tanto inmediatos como a futuro. Objetivo: Evaluar la postura de mujeres nuligestas en edad fértil acerca de las vías del parto a través de sus conocimientos, percepciones y preferencias. Método: Estudio de corte transversal. Se aplicó una encuesta a estudiantes universitarias para la recopilación de datos mediante SPSS, y análisis con prueba de diferencias de proporciones y de χ2. Resultados: 210 mujeres encuestadas. Un 80% de ellas desconoce la menor morbilidad infantil asociada a un parto vaginal, más de la mitad estima una ventaja de la cesárea que evite el dolor y un gran porcentaje desconoce los riesgos médicos asociados a la cesárea. Conclusiones: Existe un alto nivel de desconocimiento respecto a beneficios, riesgos y consecuencias de las diferentes vías del parto.

Abstract Introduction: Both in South America and worldwide, the increase in the rate of elective caesarean sections has been overwhelming. This is considered a public health problem, since vaginal delivery is the most physiological route for birth and brings health benefits for the mother and the newborn, immediately and in the future. Objective: To evaluate the position of nulliparous women of childbearing age regarding the delivery pathways through their knowledge, perceptions, and preferences. Method: Cross-sectional study with an analytical component. A survey was applied to university students for data collection through SPSS, and analysis was made with the difference of proportions and χ2 test. Results: 210 women surveyed; 80% of them are unaware of the lower infant morbidity associated with a vaginal delivery, more than a half estimate an advantage of a cesarean section that it avoids pain, and a large percentage are unaware of the medical risks associated with cesarean sections. Conclusions: There is a high level of ignorance regarding the benefits, risks and consequences of the different delivery routes.

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BACKGROUND AND PURPOSE: Most women suffer some degree of perineal trauma during vaginal delivery. Second stage management strategies, including vocalization, to protect the perineum have been investigated. OBJECTIVE: To compare the frequency and degree of perineal trauma at vaginal delivery, with and without use of the vocalization maneuver during the second stage of labor. MATERIALS AND METHODS: This is an open-label, randomized controlled trial. We conducted the study at the Center for Normal Deliveries of IMIP. We included low-risk women without prior cesarean deliveries. Women who met the inclusion criteria and signed the informed consent form were randomized to one of two groups: Group A (experimental) and Group B (control). A physical therapist encouraged women in Group A to maintain an open glottis during pushing and to emit sounds when exhaling (vocalization). Women in Group B underwent routine humanized vaginal deliveries. The outcomes of the study were perineal integrity and degree of perineal laceration. These were measured by the study team immediately after completion of the third stage of labor. RESULTS: Women in Group A tended to have less severe perineal tear (less second and third degree lacerations) and smaller lacerations than women in group B. The vocalization maneuver reduced the risk of a perineal tear greater than 2 cm by 68% (NNT 2.2). There was no difference in other outcomes. CONCLUSION: Encouraging women to follow a vocalization protocol coached by a physical therapist during the second stage of labor can be a helpful labor assistance technique, since this study showed that vocalization is associated with less extensive perineal tears. CLINICAL TRIAL REGISTRATION: This study was registered on ClinicalTrials.gov (www. CLINICALTRIAL: gov) registration number: NCT03605615.

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OBJECTIVE: This study aimed to evaluate if manual rotation, undertaken during labor, of fetuses in occiput posterior or occiput transverse position led to an increased rate of spontaneous vaginal delivery. DATA SOURCES: Searches were performed in MEDLINE, Ovid, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials with the use of a combination of keywords and text words related to "occiput posterior," "occiput transverse," and "manual rotation" from inception of the databases to July 2021. STUDY ELIGIBILITY CRITERIA: We included all randomized controlled trials evaluating manual rotation of fetuses in the occiput posterior or occiput transverse position during labor. METHODS: The primary outcome was the rate of spontaneous vaginal delivery. Meta-analyses were performed using the random effects model of DerSimonian and Laird to determine the relative risks or mean differences with 95% confidence intervals. RESULTS: A total of 643 records were screened with inclusion of 6 articles and 1002 randomized patients. All included studies compared manual rotation of fetuses in occiput posterior or occiput transverse position, all confirmed using ultrasound examinations, after complete cervical dilation with either no rotation or a sham rotation procedure. There was no difference in the rate of spontaneous vaginal delivery with manual rotation (relative risk, 1.07; 95% confidence interval, 0.95-1.20) nor was there any difference in any other maternal or fetal outcomes. In a subgroup analysis of occiput posterior fetuses, there was a 12.80-minute decrease in the length of the second stage of labor in the manual rotation group (mean difference, -12.80; 95% confidence interval, -22.61 to -2.99). There were no significant differences in any other maternal or fetal outcomes in the occiput posterior subgroup and no differences in the occiput transverse subgroup. CONCLUSION: Prophylactic manual rotation of fetuses in occiput posterior or occiput transverse position, confirmed using ultrasound examination, did not increase the rate of spontaneous vaginal delivery compared with no manual rotation. Manual rotation of the occiput posterior fetal head early during the second stage of labor was associated with a significant 12.8-minute decrease in the length of the second stage of labor with no changes in any other maternal or fetal outcomes. There were no differences demonstrated for fetuses rotated from occiput transverse position or for the combination of occiput posterior and occiput transverse fetuses. Because there is some evidence of benefit, prophylactic manual rotation can be offered to patients during the second stage of labor presenting with occiput posterior position of the fetal head documented during ultrasound examination.

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OBJECTIVE: To study the relationship between cesarean Delivery (CD) and overweight in preschool children, considering the presence of birth aspects and demographic characteristics that have been associated with the risk of excess weight. METHODS: This retrospective cross-sectional analysis used representative data of children from 2 to 6 years of age at municipal daycare centers in Taubaté, São Paulo, Brazil. The sample included 752 preschoolers. Weight and height were collected in daycare centers, and the nutritional status classification was performed using z scores of Body Mass Index (zBMI). Data analysis was performed in the bivariate and multivariate manner, the latter with the inclusion of another possible risk factor. Adjustments were made for daycare centers time, sex, birth length and weight and maternal schooling. RESULTS: The mean age of preschool children was 4.7 years, and 53.8% were boys. The prevalence of overweight children was 21.7%. The median zBMI of the children born by CD was higher than that of vaginal Delivery (p = 0.0194). The prevalence of overweight showed association with CD (p = 0.0196; PR = 1.397 with 95% CI of 1065-1831). Logistic binary multivariate regression analysis confirmed the association, even in the presence of other possible risk factors (CR: 1.580, 95% CI: 1.072-2.330). CONCLUSION FOR PRACTICE: Birth by CD is one of the factors that are associated with the early development of overweight in preschoolers.

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Objectives: To determine the proportion of successful vaginal deliveries in women with prior cesarean section; to describe maternal and perinatal complications; and to examine the factors associated with vaginal delivery. Materials and methods: Descriptive cross-sectional study of women with a history of cesarean delivery, gestational age of more than 24 weeks, singleton live fetuses, with prior vaginal delivery who received care in a high complexity public institution in 2019. Patients with a history of more than one cesarean section or myomectomy were excluded. Consecutive sampling was used. Sociodemographic and obstetric variables, delivery route and maternal and perinatal complications were measured. A descriptive analysis as well as a multivariate exploratory analysis of the factors associated with successful vaginal delivery were carried out. Results: Among 286 pregnant women included, the percentage of successful vaginal deliveries was 74.5 %. Maternal complications were identified in 3.2 % of vaginal delivery cases and in 6.8 % of cesarean births. Complications occurred in 1.3 % of all live neonates; there were 2 perinatal deaths. An association was found between successful vaginal delivery and a history of prior vaginal delivery (OR: 2.7; 95 % CI: 1.15-6.29); a Bishop score greater than 6 (OR: 2.2; 95 % CI: 1.03-4.56); spontaneous labor initiation (OR: 4.5; IC 95 % CI: 2.07-9.6); and maternal age under 30 years (OR:2.28; 95 % CI: 1.2-4.2). Conclusions: Vaginal delivery is a safe option to consider in patients with prior cesarean section, in particular in cases of spontaneous labor initiation or prior vaginal delivery. Prospective cohorts are needed in order to confirm these findings.

Objetivos: determinar la proporción de parto vaginal exitoso en mujeres con cesárea previa, describir las complicaciones maternas y perinatales, y realizar una aproximación a los factores asociados al parto vaginal. Materiales y métodos: estudio de corte transversal descriptivo. Se incluyeron mujeres con antecedente de un parto por cesárea, con edad gestacional mayor a 24 semanas y fetos únicos vivos que tuvieron prueba de parto vaginal, atendidas en una institución pública de alta complejidad en 2019. Se excluyeron aquellas pacientes con antecedente de más de una cesárea o miomectomía. Muestreo consecutivo. Se midieron variables sociodemográficas, obstétricas, vía del parto y complicaciones maternas y perinatales. Se hace análisis descriptivo y un análisis exploratorio multivariado de los factores asociados al parto vaginal exitoso. Resultados: de 286 gestantes incluidas, el porcentaje de éxito de parto vaginal fue del 74,5 %. Se identificaron complicaciones maternas en el 3,2 % de los partos vaginales y en el 6,8 % de las cesáreas. El 1,3 % de los recién nacidos tuvo alguna complicación. Hubo 2 muertes perinatales. Se encontró asociación entre parto vaginal exitoso y tener antecedente de parto vaginal (OR: 2,7; IC 95 %: 1,15-6,29); puntaje de Bishop mayor de 6 (OR: 2,2; IC 95 %: 1,03-4,56); inicio de trabajo de parto espontáneo (OR: 4,5; IC 95 %: 2,07-9,6); y edad materna menor de 30 años (OR: 2,28; IC 95 %: 1,2-4,2). Conclusiones: el parto vaginal es una opción segura para considerar en pacientes con cesárea anterior, especialmente si inician trabajo de parto espontáneo o han tenido un parto vaginal previamente. Se requieren cohortes prospectivas para confirmar estos hallazgos.

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BACKGROUND: The influence of birth mode on redox balance is unknown in dogs. We aimed to compare antioxidant activity and oxidative stress of puppies born by elective c-section or vaginal delivery. METHODS: Twenty-one bitches were elected for spontaneous vaginal delivery (n = 10) and elective cesarean section (n = 11) groups, considering only the first and last puppies born. Neonatal oxygen saturation, lactatemia, superoxide dismutase (SOD), reduced glutathione (GSH), glutathione peroxidase (GPx) and total antioxidant capacity; marker of oxidative stress (thiobarbituric acid reactive substances [TBARS]) and protein oxidation were analysed at birth, 1 h, 12 h, 24 h and 72 h. RESULTS: C-section newborns had lower oximetry at birth and 1 h. Lactatemia was higher in the last vaginal delivery puppies and higher at birth, and 1 h. Regardless of birth mode, last puppies had hyperlactatemia at birth. Vaginal delivery puppies had higher TBARS, while protein oxidation was higher in c-section, mostly in last puppies. C-section puppies had higher GPx activity, whereas GSH concentration decreased overtime. Surgically born puppies had lowering SOD between 12 h and 72 h. CONCLUSIONS: Vaginal delivery enhances lipid peroxidation, counteracted mostly by GPx. Conversely, c-section triggers protein oxidation, acutely scavenged by SOD and GSH, thus puppies are less exposed to the negative consequences of oxidative stress.

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OBJECTIVE: To assess the role of cervical length when predicting vaginal delivery after a previous cesarean section (CS) in women with low Bishop score following the use of a double-balloon catheter for induction of labor (IOL). METHODS: A prospective, longitudinal study was conducted at a large teaching hospital in Santiago to recruit pregnant women at term with a previous CS and Bishop score ≤6 for IOL with a double-balloon catheter. The device was maintained for up to 24 h and the patient continued IOL with oxytocin only if the Bishop score was >6. Demographic and clinical variables were recorded and compared against vaginal delivery as the primary outcome. Multivariate logistic regression analysis was used to compare perinatal demographic and clinical variables in women achieving vaginal delivery versus those having a repeat CS. RESULTS: The final cohort included 40 pregnant women. Women achieving vaginal delivery (n = 17, 42.5%) had statistically significant differences in mean cervical length (24.8 mm versus 33.4 mm, respectively; p = .006), median Bishop score after removing the double-balloon catheter (11 versus 7, respectively; p = .005), and mean interval between double-balloon catheter placement and vaginal delivery or the decision to perform a CS (17.4 h versus 23.6 h, respectively; p = .03). Backward stepwise selection revealed an odds ratio of 0.90 (95% confidence interval = 0.82-0.98) for cervical length and a receiver operating characteristic curve area of 0.73. CONCLUSION: Cervical length, as determined by transvaginal sonography, proved to be effective in predicting vaginal delivery in women with a previous CS and low Bishop score following the use of a double-balloon catheter for IOL.

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OBJECTIVE: Analyze newborns diagnosed with SARS-CoV-2 performed with RT-PCR at birth or during the first days of birth and to look for an association with the route of birth. METHODS: We conducted a comprehensive literature search for newborns diagnosed with COVID-19 using PubMed, LILACS and Google scholar until May 15, 2020, looking for published articles with pregnancy, vertical transmission, intrauterine transmission, neonates, delivery. RESULTS: There were found 10 articles with a total of 15 newborn infected with SARS-CoV-2 according to positive PCR at birth or in the first days of birth. Eleven newborn birth by cesarean section and 4 vaginally. Of the 11 cases with cesarean section, two presented premature rupture of the membranes. Seven newborns developed pneumonia, of which two had ruptured membranes and one was born by vaginal delivery. CONCLUSION: This review shows that there is perinatal or neonatal infection with SARS-CoV-2 by finding a positive PCR in the first days of birth. In addition, that there is more possibility of neonatal infection if the birth is vaginal or if there is premature rupture of the membranes before cesarean section. Vaginal delivery and premature rupture of membranes should be considered as risk factors for perinatal infection.

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OBJECTIVE: To identify clinical and demographic factors associated with missing strings and expulsion after postplacental insertion of copper T380A intrauterine devices (TCu380A IUD). METHODS: This is a secondary analysis of an implementation study. We followed participants who had a postplacental TCu380A IUD insertion, at two postpartum visits: 45-90 days (visit 1) and 6-9 months (visit 2). We used multiple log-binomial regression models to evaluate the demographic and clinical variables associated with missing strings and with IUD expulsion. RESULTS: We included 705 participants who had a postplacental IUD insertion. We observed missing strings in 275 (47.9%) participants at visit 1, and in 127 (34.2%) participants at visit 2. We identified 61 expulsions (8.9%) by visit 2. In the multiple regression models, only the delivery type was associated with missing strings and expulsion. Compared with vaginal delivery, cesarean delivery increased the risk of missing strings (adjusted relative risk [aRR] 6.21; 95% confidence interval [CI] 4.29-8.99) but reduced the risk of IUD expulsion (aRR 0.24; 95% CI 0.13-0.43). CONCLUSION: The delivery mode was the only factor associated with missing strings and expulsion after postplacental IUD insertion. Cesarean section was associated with an increased risk of missing strings but decreased risk of expulsion after postplacental TCu380A IUD insertion.

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